| NPI | 1578689071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S04087) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-30443) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2022-01-04 |