NPI | 1124169990 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28117) |
Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC10621) |
Enumeration Date | 2007-02-12 |
Last Update Date | 2012-03-27 |