| NPI | 1760657373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-2355) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30867) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2023-10-11 |