| NPI | 1689468936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 16267) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B02062) |
| 111N00000X Chiropractor (Licence: ME CR3159) | |
| 111N00000X Chiropractor (Licence: WA CH61580984) | |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2026-05-24 |