| NPI | 1164390449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WI 6375-12) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2025040270) |
| 111N00000X Chiropractor (Licence: CO CHR.0008954) | |
| Enumeration Date | 2025-10-28 |
| Last Update Date | 2026-01-21 |