| NPI | 1386098051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5744) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11800) |
| 111N00000X Chiropractor (Licence: WA CH6145082) | |
| 111N00000X Chiropractor (Licence: CO CHR.0007856) | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2025-10-02 |