| NPI | 1790980811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 21036) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 5203) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2013-07-31 |