| NPI | 1992456164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01902) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC36177) |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2022-01-10 |