| NPI | 1710602412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01942) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NV B01942) |
| Enumeration Date | 2022-10-05 |
| Last Update Date | 2022-10-27 |