| NPI | 1104941301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC27552) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC9623) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |