| NPI | 1164753588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33645) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x011911-1) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2018-10-23 |