| NPI | 1245379445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P17575) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2025-03-10 |