| NPI | 1063424125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3502) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28627) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2019-03-13 |