| NPI | 1720210057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 26063) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3918) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2015-04-17 |