| NPI | 1619134954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3254) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30920) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2011-04-14 |