| NPI | 1114076031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC27858) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 27858) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2021-11-08 |