| NPI | 1003251182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 23228) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GU C000021) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2013-05-02 |