| NPI | 1356790281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5922) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33582) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2021-06-04 |