| NPI | 1144421785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 911878152) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 911878152) |
| 111NX0800X Chiropractor, Orthopedic (Licence: CA 911878152) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2008-07-24 |