| NPI | 1982626263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC16782) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA 16782) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2020-01-08 |