| NPI | 1750056735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 812) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 13662) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2023-01-31 |