| NPI | 1881637486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC27463) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: CA DC27463) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2015-02-19 |