| NPI | 1386080885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC32314) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI 1259) |
| Enumeration Date | 2013-05-12 |
| Last Update Date | 2020-01-23 |