| NPI | 1003185414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32140) |
| Additional Taxonomies | 111NT0100X Chiropractor Thermography (Licence: CA 32140) |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2016-01-25 |