| NPI | 1104160795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: CA 16088) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA 16088) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-11-20 |