| NPI | 1558875930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: UT 6175357-1202) |
| Enumeration Date | 2017-11-21 |
| Last Update Date | 2025-04-11 |