| NPI | 1558951947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9237) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010488) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2022-12-04 |