NPI | 1376520775 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
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 |