| NPI | 1720453848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2008008295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05416) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2020-03-31 |