| NPI | 1538894241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01944) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 12434095-1202) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2024-06-12 |