| NPI | 1770510703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 30258) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI 1044) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2011-09-23 |