| NPI | 1437573458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1671) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC32820) |
| Enumeration Date | 2014-02-11 |
| Last Update Date | 2019-09-18 |