| NPI | 1437873163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 122064) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 6004-12) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2023-12-12 |