| NPI | 1235213430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6297) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556549) |
| 111N00000X Chiropractor (Licence: WA CH00034494) | |
| 111N00000X Chiropractor (Licence: MA 3192) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2025-08-01 |