| NPI | 1639343841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 14218) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 1635) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2008-04-17 |