| NPI | 1558700328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32891) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8322) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2019-04-04 |