| NPI | 1881800670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC16829) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4279) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-03-02 |