| NPI | 1538326277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC30894) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC30894) |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2011-10-25 |