| NPI | 1235023532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16433) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID 9371160) |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2025-06-03 |