| NPI | 1528037553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 2400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 28030) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2015-12-03 |