| NPI | 1376513937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC-29844) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 11953) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2012-03-07 |