| NPI | 1770743486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC25041) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA DC25041) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2008-06-16 |