| NPI | 1922238898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 03623) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC31259) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2013-02-26 |