| NPI | 1306022553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3934) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30686) |
| Enumeration Date | 2008-01-18 |
| Last Update Date | 2022-10-03 |