| NPI | 1174369797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2865) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR011233) |
| Enumeration Date | 2024-07-03 |
| Last Update Date | 2025-08-21 |