| NPI | 1154715399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: UT 9585273-1202) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32205) |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2016-03-31 |