| NPI | 1851302509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC17974) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CA DC17974) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2013-09-12 |