| NPI | 1699662288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9457) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 37244) |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2025-06-18 |