| NPI | 1811347743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 20201009987) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05807) |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2021-04-15 |