| NPI | 1538708011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6121) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34713) |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2021-01-22 |