| NPI | 1578877692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1414) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31612) |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2010-10-18 |