| NPI | 1245433747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30053) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011420) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2014-01-16 |