| NPI | 1649905936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5509) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557830) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-07-20 |