| NPI | 1629040373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 12273) |
| Additional Taxonomies | 111NX0100X Chiropractor Occupational Health (Licence: CA DC 12273) |
| 111NX0800X Chiropractor Orthopedic (Licence: CA DC 12273) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2010-08-13 |