| NPI | 1316803489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 04274) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104558125) |
| Enumeration Date | 2026-01-01 |
| Last Update Date | 2026-01-11 |