| NPI | 1831614379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 33985) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33985) |
| 111NX0100X Chiropractor, Occupational Health (Licence: CA 33985) | |
| Enumeration Date | 2017-08-05 |
| Last Update Date | 2017-08-05 |