| NPI | 1093765711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA A05311) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 2329) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2025-08-08 |