| NPI | 1588960074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 4068) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32776) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2014-02-19 |