| NPI | 1225480221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4655) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4158) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2026-03-03 |