| NPI | 1295994101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 28089) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA 28089) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2012-06-15 |