| NPI | 1013104595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30504) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 30504) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2008-09-11 |