| NPI | 1417435322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4869) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 4302) |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2025-10-08 |