| NPI | 1871177238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC0000003540) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 22481) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2022-09-12 |