| NPI | 1952493991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3261) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC20126) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-10-19 |