| NPI | 1730235573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6446) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 956) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2025-10-13 |