| NPI | 1295794972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 17503) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 827CHI) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2011-07-13 |