| NPI | 1649686114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32933) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3456) |
| Enumeration Date | 2014-07-06 |
| Last Update Date | 2014-07-06 |