| NPI | 1972135341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2020003790) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2023-11-01 |