| NPI | 1902939648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: CA 30918) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2812) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2013-03-01 |