| NPI | 1164586590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD SD845) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: SD 845) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2025-08-25 |