| NPI | 1851572325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5849) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 5119) |
| Enumeration Date | 2007-11-26 |
| Last Update Date | 2025-07-15 |