| NPI | 1972981629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT CHI-CHI-LIC-7351) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC33284) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2022-02-28 |