| NPI | 1366553000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MO 2019005953) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: TX 6915) |
| 111N00000X Chiropractor (Licence: CA 24763) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2026-01-19 |