| NPI | 1235969395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557998) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9487) |
| Enumeration Date | 2024-08-05 |
| Last Update Date | 2025-09-29 |