| NPI | 1518905082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3725) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 24341) |
| 111N00000X Chiropractor (Licence: NC 4006) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2016-10-26 |