| NPI | 1003842238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B02011) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 29177) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2015-02-26 |