| NPI | 1568534733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1820) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC29440) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2018-02-23 |