| NPI | 1558645796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32105) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: CA 32105) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2011-10-06 |