| NPI | 1164805750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1760) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33328) |
| Enumeration Date | 2015-07-01 |
| Last Update Date | 2017-04-24 |