| NPI | 1871256297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013829) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH61218924) |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2024-08-12 |