| NPI | 1851694012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC22582) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 8123653-1202) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2021-09-26 |