| NPI | 1215372982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 20053) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 14477) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2013-05-07 |