| NPI | 1386304012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 748) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010294) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2021-12-21 |