| NPI | 1912473224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID chia1945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557516) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2025-02-13 |