| NPI | 1518990969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 15362) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29328) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2021-10-27 |