| NPI | 1558387563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 31863) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 9185) |
| 111N00000X Chiropractor (Licence: IL 38009937) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2019-07-24 |