| NPI | 1467917096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30433) |
| Additional Taxonomies | 111NX0100X Chiropractor Occupational Health (Licence: CA 30433) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2019-02-07 |