| NPI | 1124340997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC16886) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: CA DC16886) |
| 111NX0800X Chiropractor Orthopedic (Licence: CA DC16886) | |
| Enumeration Date | 2010-02-22 |
| Last Update Date | 2010-02-22 |