| NPI | 1285276758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-6133) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34668) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2020-02-12 |