| NPI | 1598757395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC25141) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6729) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2013-07-03 |