| NPI | 1912576356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2727) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 05056) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2022-11-15 |