| NPI | 1801478631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104-557721) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010424) |
| 111N00000X Chiropractor (Licence: SC 4515) | |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-21 |