| NPI | 1760157671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: MS 1420) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MS 09370) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2026-04-07 |