| NPI | 1801888128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B-168) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 11850) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2015-08-12 |