| NPI | 1457030736 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 2194) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 121215) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2024-11-14 |