| NPI | 1952551491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA dc30977) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2008009305) |
| 111NX0800X Chiropractor, Orthopedic (Licence: ID CHIA-1309) | |
| Enumeration Date | 2008-09-20 |
| Last Update Date | 2010-01-27 |