| NPI | 1770789950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2007010882) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2024-01-31 |