| NPI | 1215370366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32752) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007530) |
| 111N00000X Chiropractor (Licence: IN 08002694A) | |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2025-11-22 |