| NPI | 1871920256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32728) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557041) |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2021-10-20 |