| NPI | 1003988023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC14161) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: CA DC14161) |
| 111NX0100X Chiropractor Occupational Health (Licence: CA DC14161) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |