| NPI | 1881926723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC31494) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31494) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2019-03-22 |