| NPI | 1245727593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 6461971) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34180) |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2024-11-12 |