| NPI | 1265577217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: OR 2714) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 21451) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2014-02-11 |