| NPI | 1134708183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9159) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 13485) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2022-05-03 |