| NPI | 1417420431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 2267) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WY 788) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2022-07-25 |