| NPI | 1275710980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 29612) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01100) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2009-01-22 |