| NPI | 1902294218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B0987) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC28680) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2015-01-09 |