| NPI | 1255666756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 31369) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 60106740) |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2011-05-24 |