| NPI | 1639582265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33141) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12636) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2015-02-26 |