| NPI | 1770178196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S04093) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B-832) |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2023-12-05 |