| NPI | 1952625667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC-31505) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AK 544) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2011-11-18 |