| NPI | 1417673666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2759) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: AL 2759) |
| 111NR0200X Chiropractor, Radiology (Licence: AL 2759) | |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2022-10-18 |