| NPI | 1700326865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 510) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12121) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2022-07-21 |