| NPI | 1548586464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 30989) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA SAT 13148) |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2011-01-04 |