| NPI | 1134277353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 19604) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 292082-1202) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-08 |