| NPI | 1205951191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC# 14791) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 2241) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-10-09 |