| NPI | 1902125669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28923) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC9781) |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2015-03-16 |