| NPI | 1336414358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA dc31065) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60713065) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2022-04-25 |