| NPI | 1093075640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32256) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01466) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2015-04-03 |