| NPI | 1235317173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01826) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 29699) |
| Enumeration Date | 2008-02-01 |
| Last Update Date | 2023-01-31 |