| NPI | 1891821369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1417) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC15672) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2011-05-26 |