| NPI | 1295597870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 5040) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: SC 5040) |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2024-01-29 |