| NPI | 1376520775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC25120) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA 25120) |
| 111NX0100X Chiropractor Occupational Health (Licence: CA 25120) | |
| 111NX0800X Chiropractor Orthopedic (Licence: CA 25120) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2007-07-08 |