| NPI | 1104214469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34021) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA 244509) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2018-03-28 |