| NPI | 1124995048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2025005526) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 2213) |
| Enumeration Date | 2025-10-23 |
| Last Update Date | 2025-10-23 |