| NPI | 1679850143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 31615) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 14513) |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2015-01-14 |