| NPI | 1134336845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA1921) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3734) |
| 101YM0800X Counselor, Mental Health (Licence: ID 4881000) | |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2026-06-06 |