| NPI | 1801483193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 9971161) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 12073146-1202) |
| Enumeration Date | 2020-12-21 |
| Last Update Date | 2025-07-25 |