| NPI | 1659320729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 17542) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4203) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2011-04-14 |