| NPI | 1962784595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36163) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008838) |
| 111N00000X Chiropractor (Licence: IL 038012390) | |
| Enumeration Date | 2011-09-09 |
| Last Update Date | 2023-12-08 |