| NPI | 1114641578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: OR 6243) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: OR 6243) |
| 111NX0100X Chiropractor, Occupational Health (Licence: OR 6243) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: OR 6243) | |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2024-12-02 |