| NPI | 1225287766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03553) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30942) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2010-09-30 |