| NPI | 1013035997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC207480) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA dc20748) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2017-03-23 |