| NPI | 1619034766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC-30778) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DC CH030064) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2017-03-06 |