| NPI | 1679232730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 115283) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225700000X Massage Therapist (Licence: IA 094910) | |
| 225700000X Massage Therapist (Licence: DE MT-0004508) | |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2022-07-11 |