| NPI | 1649706839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002965A) |
| 111N00000X Chiropractor (Licence: IL 038013090) | |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2026-03-15 |