| NPI | 1952311763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC20119) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CA DC20119) |
| 111NX0800X Chiropractor, Orthopedic (Licence: CA DC20119) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-03-30 |