| NPI | 1548911274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B02040) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-2223) |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2024-06-18 |