| NPI | 1104501667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1610) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2813) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2024-07-13 |