| NPI | 1578650867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B00691) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 19363) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2016-10-20 |