| NPI | 1225369697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: CA 31504) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31504) |
| Enumeration Date | 2010-01-24 |
| Last Update Date | 2010-01-24 |