| NPI | 1386978179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: AR 15642) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 15642) |
| Enumeration Date | 2009-09-25 |
| Last Update Date | 2025-08-29 |