| NPI | 1215055801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: CA 013939) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CA 013939) |
| 111NN1001X Chiropractor, Nutrition (Licence: CA 013939) | |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |