| NPI | 1740686567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 12643) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 1940) |
| 111N00000X Chiropractor (Licence: WA CH60319280) | |
| 111N00000X Chiropractor (Licence: CA 15146) | |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2015-03-17 |