| NPI | 1376693424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC-30972) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 425) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-11-21 |