| NPI | 1043369317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B00388) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 19602) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-12-11 |