| NPI | 1609832468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 11-00008633) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2522) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2009-12-22 |