| NPI | 1710435086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 0651) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR009725) |
| Enumeration Date | 2016-09-15 |
| Last Update Date | 2024-10-22 |