| NPI | 1366508590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2481) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28415) |
| Enumeration Date | 2006-12-30 |
| Last Update Date | 2022-04-12 |