| NPI | 1174900799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: NE 1788) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1788) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2025-02-20 |