| NPI | 1740854223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 1084) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 35050) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2025-03-19 |