| NPI | 1992012678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 31730) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 2444277) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2018-03-17 |