| NPI | 1609074079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 19640) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: CA 19640) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2024-06-12 |