| NPI | 1790020097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: CA 33346) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012319) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2016-02-16 |