| NPI | 1497160931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32985) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 0175) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2014-06-23 |