| NPI | 1942602255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33035) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC16303) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2016-05-17 |