| NPI | 1710134127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30985) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30985) |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2016-11-30 |