| NPI | 1851540942 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC20613) | 
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: CA DC20613) | 
| Enumeration Date | 2008-09-12 | 
| Last Update Date | 2011-02-28 |