| NPI | 1376707596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5844) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30832) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2020-06-10 |