| NPI | 1972753796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32074) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011248) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2012-09-14 |