| NPI | 1619116530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33602) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60072117) |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2022-07-21 |