| NPI | 1003071663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC30142) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC17256) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2017-01-17 |