| NPI | 1881713162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC16802) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3666) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |