| NPI | 1508601451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104558114) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2024025434) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2026-03-10 |