| NPI | 1205194651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32274) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 14661) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2016-08-09 |