| NPI | 1396918686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 6799308-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 23114) |
| 111N00000X Chiropractor (Licence: UT 6799308-8007) | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2020-04-23 |