| NPI | 1508100363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC32425) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08002501A) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2021-08-01 |