| NPI | 1043374911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 7201080-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA dc28616) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2010-09-03 |