| NPI | 1982318689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1454) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: SD 1454) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-07-12 |