| NPI | 1790763902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 13541) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 24441) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2007-07-09 |