| NPI | 1467782441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 21952) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 0184) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2016-03-30 |