| NPI | 1982146502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36022) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6261) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2021-02-11 |