| NPI | 1942706692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2018003110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13770) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2019-05-18 |