| NPI | 1033361092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC31049) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31049) |
| Enumeration Date | 2008-10-21 |
| Last Update Date | 2009-04-09 |