| NPI | 1548320526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4055) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC24388) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-07-02 |