| NPI | 1750034179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 2111) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 112604) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2022-06-01 |