| NPI | 1174727499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 016538) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 06538) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2017-07-20 |