| NPI | 1679942775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 825) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2015031532) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2024-07-06 |