| NPI | 1093011694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32563) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012118) |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2015-07-07 |