| NPI | 1881076404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2015018443) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05732) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2022-11-15 |