| NPI | 1801820451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA1193) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 13665) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2017-01-12 |