| NPI | 1205159639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC31517) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 14315) |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2014-06-12 |