| NPI | 1689694663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC21346) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-06153) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2023-06-30 |