| NPI | 1982172615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5393) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 3157) |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2025-02-04 |