| NPI | 1255814984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16427) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011387) |
| 111N00000X Chiropractor (Licence: CO CHR.0007894) | |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2024-01-16 |