| NPI | 1073505236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 25082) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 25082) |
| 111NX0100X Chiropractor, Occupational Health (Licence: CA 25082) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2007-07-08 |