| NPI | 1134953813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: PR 945) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: PR 945) |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2024-08-27 |