| NPI | 1508305129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34627) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4685) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2020-03-24 |