| NPI | 1316020027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30933) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3096) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2013-07-01 |