| NPI | 1164544136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33933) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5641) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2022-07-21 |