| NPI | 1114358470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5548) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32966) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2018-10-17 |