| NPI | 1366467102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA 20A11925) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC25815) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2017-04-16 |