| NPI | 1649976507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2024002468) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 4530) |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2025-04-30 |