| NPI | 1245820935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 36191) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010479) |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2022-03-05 |