| NPI | 1699071704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2022046599) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7872333-1202) |
| 111N00000X Chiropractor (Licence: WA CH60281895) | |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2022-11-30 |