| NPI | 1255494167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 7230) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32769) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2025-08-20 |