| NPI | 1518616259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 843) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: PR 843) |
| Enumeration Date | 2022-03-21 |
| Last Update Date | 2023-03-31 |