| NPI | 1407455090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 743) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PR 743) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2021-06-01 |