NPI | 1578104931 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 000784) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010279) |
Enumeration Date | 2019-10-07 |
Last Update Date | 2025-01-24 |