| NPI | 1902330434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA dc33293) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: CA rhc00202341) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2017-04-11 |