| NPI | 1508697236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: PR 0971) |
| Additional Taxonomies | 111NR0400X (Licence: PR 0971) |
| 111NS0005X Chiropractor, Sports Physician (Licence: PR 0971) | |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-08-13 |