| NPI | 1891385092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-6717) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AR 12456) |
| Enumeration Date | 2021-01-21 |
| Last Update Date | 2026-01-13 |