| NPI | 1538361548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3471) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 28346) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2018-05-16 |