| NPI | 1346265873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC29860) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA 29860) |
| 111NI0013X Chiropractor Independent Medical Examiner (Licence: CA 998706) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2009-01-08 |