| NPI | 1376186148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: ID CHIA-1964) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: OR CHIA-6171) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2023-10-23 |