| NPI | 1629954839 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16565) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0008976) |
| 175F00000X Naturopath (Licence: VT 099.0134281) | |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2026-02-05 |