| NPI | 1790734572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC29675) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 29675) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2021-07-21 |