| NPI | 1619141280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 18753) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: CA 18753) |
| 111NX0800X Chiropractor, Orthopedic (Licence: CA 18753) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |