| NPI | 1265760664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 19390) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9731) |
| 111N00000X Chiropractor (Licence: NJ 38MC00652000) | |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2009-11-23 |