| NPI | 1649482027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor Occupational Health (Licence: CA 18783) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: CA 18783) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2007-07-09 |