| NPI | 1356642425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV BO1800) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA CA 15843) |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2023-07-25 |