| NPI | 1104571298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5426) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 5246) |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2022-08-02 |