| NPI | 1053330795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 111N00000X) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA 111NX0800X) |
| 111NN0400X Chiropractor, Neurology (Licence: CA 111NN0400X) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-06-29 |