| NPI | 1538197629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC15637) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 15637) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2011-08-02 |