| NPI | 1609055607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC15629) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 534727) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2015-04-21 |