| NPI | 1104542356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2756) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: AL 2756) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2022-10-18 |