| NPI | 1669420378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 12407599-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 27993) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-10-31 |