| NPI | 1437512399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN 3411) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 335533) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2022-01-31 |