| NPI | 1760488084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: NV B01313) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25296) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-07-27 |