| NPI | 1639303993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6324) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33936) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2023-12-14 |