| NPI | 1083784870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC17455) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 22943) |
| 111NX0800X Chiropractor, Orthopedic (Licence: CA 2240) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2010-02-22 |