| NPI | 1457568867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 17473) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA-1238) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2008-10-24 |