| NPI | 1649406661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC31280) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7266584-1202) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2013-11-12 |