| NPI | 1578811535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32368) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 15461) |
| Enumeration Date | 2012-08-24 |
| Last Update Date | 2016-06-06 |