| NPI | 1114102712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4578) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5986) |
| 111N00000X Chiropractor (Licence: PA 009932) | |
| 111N00000X Chiropractor (Licence: CA DC30383) | |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2025-07-24 |