| NPI | 1477252799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9366) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 119101) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2024-05-27 |