| NPI | 1023101029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC21345) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC21345) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2010-04-13 |