| NPI | 1154659415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25878) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2024-04-25 |