| NPI | 1528640505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 13113415-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: WI 627812) |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2025-02-04 |