| NPI | 1811415300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2022049135) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: MO 2022049135) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2023-01-30 |