| NPI | 1437372679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA CADC21870) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 18866) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-11-10 |