| NPI | 1558426254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 20772) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY xoo5987-1) |
| Enumeration Date | 2006-12-25 |
| Last Update Date | 2007-07-08 |