| NPI | 1831551043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2018036900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012783) |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2019-03-20 |