| NPI | 1316911753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104001092) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 21170) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2018-08-01 |