| NPI | 1801492525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1996) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 13060) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2024-06-13 |