| NPI | 1215297536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 27750) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 3526) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-05-21 |