| NPI | 1215962444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: CA DC 15470) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: AZ 3812) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2007-12-12 |