| NPI | 1780056317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2016004508) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05754) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2022-07-25 |