| NPI | 1659656056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC32061) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11848) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2015-02-03 |