| NPI | 1598863979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007104) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC-30051) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2011-03-04 |