| NPI | 1760908685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33988) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 10436204-1202) |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2017-08-22 |