| NPI | 1003696451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5896) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3805) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2026-02-23 |