| NPI | 1386789337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 35199) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: LA 1268) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2024-10-11 |