| NPI | 1235367046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor Orthopedic (Licence: CA 12557) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: OK 3645) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2009-06-30 |