| NPI | 1407824071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WA CH61020299) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 31802) |
| 111N00000X Chiropractor (Licence: IA 4822) | |
| 111N00000X Chiropractor (Licence: MN 3578) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-04-22 |