| NPI | 1336267889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 17685) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X004889) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-09 |