| NPI | 1215128632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1418) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 15720) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2018-03-14 |