| NPI | 1548573512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X (Licence: CA 32574) |
| Additional Taxonomies | 111NR0400X (Licence: TX 11517) |
| 111N00000X Chiropractor (Licence: CA 32574) | |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2017-02-28 |