| NPI | 1235713892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 1172) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ND student) |
| 111N00000X Chiropractor (Licence: ND NA) | |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2023-04-12 |