| NPI | 1922614007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: NV B01850) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NV B01850) |
| 111N00000X Chiropractor (Licence: NV B01850) | |
| 111NN1001X Chiropractor, Nutrition (Licence: NV B01850) | |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-09-23 |