| NPI | 1972665479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32603) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 4410) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2016-08-10 |