| NPI | 1295062206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34813) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 5263) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2024-10-15 |