| NPI | 1669797692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 23604) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI 763) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2014-05-28 |