| NPI | 1346230059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC14155) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 004511) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2007-07-08 |