| NPI | 1568923480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: VA 0104-557561) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104-557561) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2023-11-03 |