| NPI | 1841475209 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3790) | 
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7938) | 
| Enumeration Date | 2008-01-04 | 
| Last Update Date | 2025-09-28 |