| NPI | 1487757340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC24596) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 13368) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2009-12-30 |