| NPI | 1528223278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33109) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008381) |
| 111N00000X Chiropractor (Licence: CO 6472) | |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2015-12-02 |