| NPI | 1801967823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC25016) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00642600) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2010-03-30 |