| NPI | 1558573444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC29650) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7809) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2011-11-28 |