| NPI | 1427139625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor Nutrition (Licence: CA DC18439) |
| Additional Taxonomies | 111NR0200X Chiropractor Radiology (Licence: CA DC18439) |
| 111NS0005X Chiropractor Sports Physician (Licence: CA DC18439) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-08 |