| NPI | 1134211170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A066088) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC24046) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2012-04-04 |