| NPI | 1043383029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 829) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC26088) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-02-26 |