| NPI | 1992746028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 10852099-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC17608) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-07-31 |