| NPI | 1700062932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28452) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL DC28452) |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2021-09-02 |