| NPI | 1639667009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: AZ 8694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8694) |
| 111NS0005X Chiropractor, Sports Physician (Licence: AZ 8694) | |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2023-05-26 |