| NPI | 1750261301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2025038344) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MO 2025038344) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: MO 2025038344) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: MO 2025038344) | |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-04 |