| NPI | 1932553534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5817) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VI 73C) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2025-11-17 |