| NPI | 1942377551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 016655) |
| Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: CA DCc 016655) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-10 |