| NPI | 1578897286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 31641) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556731) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2011-09-28 |