| NPI | 1720606874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4717) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557592) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2021-10-04 |