| NPI | 1720249485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33705) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI 1107) |
| 111N00000X Chiropractor (Licence: CO chr0007015) | |
| 111N00000X Chiropractor (Licence: OR 5662) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2016-10-19 |