| NPI | 1477096196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36054) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 24-01067) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2021-05-07 |