| NPI | 1417939042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA dc15115) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: CA dc15115) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2009-02-23 |