| NPI | 1083741144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC10776) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC001454L) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2008-06-09 |