| NPI | 1558368027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 22989) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 2844) |
| 111N00000X Chiropractor (Licence: WA 2792) | |
| 111N00000X Chiropractor (Licence: AZ 5095) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2007-07-08 |