| NPI | 1326757808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 990) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010832) |
| Enumeration Date | 2022-11-23 |
| Last Update Date | 2024-09-27 |