| NPI | 1568502698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3742) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC27312) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-10-10 |