| NPI | 1356563647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC27331) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 27330) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-06-28 |