| NPI | 1568599843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR OR3608) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-26910) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2007-07-10 |