| NPI | 1982797262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 006774) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010154) |
| Enumeration Date | 2006-10-01 |
| Last Update Date | 2024-03-13 |