| NPI | 1740877687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6123) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9221) |
| Enumeration Date | 2020-12-27 |
| Last Update Date | 2024-11-11 |