| NPI | 1194965079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 30948) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CO 6126) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2009-03-04 |