| NPI | 1578572525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 233450) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1719) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AK 233450) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2025-05-01 |