| NPI | 1275749897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC25838) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: CA DC25838) |
| 111NS0005X Chiropractor Sports Physician (Licence: CA DC25838) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |