| NPI | 1891792131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 3498) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-26289) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2024-05-08 |