| NPI | 1891265534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: FL 13816) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 13816) |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2026-08-15 |