| NPI | 1679431167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 7389) |
| Enumeration Date | 2026-01-13 |
| Last Update Date | 2026-02-11 |