| NPI | 1720031818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B00576) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC23163) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-01-17 |