| NPI | 1790343598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36518) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 10195) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2021-09-30 |