| NPI | 1154490050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01340) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S1340) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: MD s01340) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2026-03-20 |