| NPI | 1639375629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: MO 2017012832) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: MO 2017012832) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2025-10-08 |