| NPI | 1568903433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ AZ8620) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8620) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2026-06-26 |