| NPI | 1508847997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01987) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 28195) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2024-05-29 |