| NPI | 1063494755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC21819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT21819) |
| Enumeration Date | 2005-11-17 |
| Last Update Date | 2009-11-19 |