| NPI | 1821770850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PR 918) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: PR 918) |
| Enumeration Date | 2023-08-01 |
| Last Update Date | 2024-03-04 |