| NPI | 1851012629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: ME CR2875) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: WA CH61330911) |
| Enumeration Date | 2022-09-08 |
| Last Update Date | 2023-02-16 |