| NPI | 1588788111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3647) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC24901) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2023-12-12 |