| NPI | 1215760202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 1043) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR011226) |
| Enumeration Date | 2024-08-23 |
| Last Update Date | 2025-04-06 |