| NPI | 1770007361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8652) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 8652) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2023-02-28 |