| NPI | 1750491858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 13506) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 13506D.C.) |
| 111N00000X Chiropractor (Licence: CA 13506 chiropractic) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2016-09-17 |