| NPI | 1720108947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 15633CA) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 2785) |
| 111N00000X Chiropractor (Licence: CA 15633DC) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2009-03-20 |