| NPI | 1811996101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4210) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28800) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2018-07-30 |