| NPI | 1407953227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30097) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556475) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-11-22 |