| NPI | 1265658017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 26570) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A97176) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |