| NPI | 1265525976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5005) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC22422) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2019-04-06 |