NPI | 1336890037 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: AZ 9460) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: WA 61243039) |
111N00000X Chiropractor (Licence: NC 5354) | |
111NS0005X Chiropractor, Sports Physician (Licence: NC 5354) | |
Enumeration Date | 2022-01-13 |
Last Update Date | 2025-07-10 |