| NPI | 1710006432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC19321) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO DC19321) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2015-09-30 |