| NPI | 1619175288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor Independent Medical Examiner (Licence: CA 20106) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: NV B-866) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2009-12-07 |