| NPI | 1982911731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 31005) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12890) |
| Enumeration Date | 2010-08-31 |
| Last Update Date | 2015-08-09 |