| NPI | 1003087156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 8161070) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC28729) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2024-10-09 |