| NPI | 1497317317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4732) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: SC 9226) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2021-10-01 |