| NPI | 1245907575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5563) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4712) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2023-11-28 |