| NPI | 1376776773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WY 823) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1378) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2025-03-12 |