| NPI | 1386323467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 13025048-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-2369) |
| Enumeration Date | 2023-07-14 |
| Last Update Date | 2025-11-19 |