| NPI | 1609086560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC0184090) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 18409) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2011-01-11 |