| NPI | 1871051318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5334) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SD 1351) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2022-12-08 |