| NPI | 1073544474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 14472) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 8326) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2007-07-08 |