| NPI | 1063672004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC24437) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC3608) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2017-10-06 |