| NPI | 1245338805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3930) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30134) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2019-12-16 |