| NPI | 1124569017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6162) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33748) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2021-10-13 |