| NPI | 1093794646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 26615) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 3626) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2008-04-14 |