| NPI | 1114075256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 18182) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: CA 18182) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |