| NPI | 1306016043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: CA DC27577) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC27577) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA DC27577) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: CA DC27577) | |
| 225100000X Physical Therapist (Licence: CA PT 35290) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2012-02-08 |