| NPI | 1588557953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S04259) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: MD S04259) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: MD S04259) | |
| 111NR0200X Chiropractor, Radiology (Licence: MD S04259) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: MD S04259) | |
| 111NN0400X Chiropractor, Neurology (Licence: MD S04259) | |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MD S04259) | |
| 111NI0900X Chiropractor, Internist (Licence: MD S04259) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: MD S04259) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: MD S04259) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: MD S04259) | |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-06-02 |