| NPI | 1972937712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33745) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038012440) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2022-09-20 |