| NPI | 1457098089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 12399) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9146) |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2025-05-08 |