| NPI | 1568703965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32521) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13378) |
| Enumeration Date | 2013-03-09 |
| Last Update Date | 2024-01-08 |