NPI | 1548317738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC29203) |
Additional Taxonomies | 111NX0100X Chiropractor, Occupational Health (Licence: CA DC29203) |
Enumeration Date | 2007-01-03 |
Last Update Date | 2007-07-08 |