| NPI | 1659644375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32181) |
| Additional Taxonomies | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: CA 32181) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2017-11-07 |