| NPI | 1003147141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32223) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NE 1609) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2013-10-10 |