| NPI | 1578695227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC20870) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC20870) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2008-02-27 |