| NPI | 1205890738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28343) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 28343) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-07-08 |