| NPI | 1821030776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 022 04832) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 04832) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2025-08-28 |