| NPI | 1811405145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2017036634) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1961) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2018-09-06 |