| NPI | 1952306953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC23747) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 23747) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2020-01-14 |