| NPI | 1194940809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA NP95013795) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC18301) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: CA DC18301) | |
| 111NN0400X Chiropractor Neurology (Licence: CA DC18301) | |
| 111NN1001X Chiropractor Nutrition (Licence: CA DC18301) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: CA DC18301) | |
| 111NS0005X Chiropractor Sports Physician (Licence: CA DC18301) | |
| 111NX0100X Chiropractor Occupational Health (Licence: CA DC18301) | |
| 111NX0800X Chiropractor Orthopedic (Licence: CA DC18301) | |
| 363LA2200X Nurse Practitioner Adult Health (Licence: CA NP95013795) | |
| 363LF0000X Nurse Practitioner Family (Licence: CA NP95013795) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: CA NP95013795) | |
| 363LX0106X Nurse Practitioner Occupational Health (Licence: CA NP95013795) | |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2020-02-10 |