| NPI | 1518392521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32718) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: CA 32718) |
| 111NR0400X Chiropractor Rehabilitation (Licence: CA 32718) | |
| 111NS0005X Chiropractor Sports Physician (Licence: CA 32718) | |
| 111NX0800X Chiropractor Orthopedic (Licence: CA 32718) | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2021-06-22 |