| NPI | 1104941434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC13319) |
| Additional Taxonomies | 111NR0400X (Licence: CA DC13319) |
| 111NX0100X Chiropractor, Occupational Health (Licence: CA DC13319) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |