| NPI | 1942075650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2324) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: ID ACP-467) |
| Enumeration Date | 2023-11-22 |
| Last Update Date | 2023-12-01 |