| NPI | 1336150705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 17831) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC17831) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2016-07-15 |