| NPI | 1437450673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: LA 1581) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: LA 1581) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2025-10-30 |