| NPI | 1457340242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC115120) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC11512) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2008-11-04 |