| NPI | 1669503421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR005186) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 23697) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2020-05-18 |