| NPI | 1164431789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 788) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: ND 1378) |
| 111NS0005X Chiropractor, Sports Physician (Licence: WI 2197) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2025-06-09 |