| NPI | 1659350924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor Occupational Health (Licence: CA 17458) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA 17458) |
| 111NN0400X Chiropractor Neurology (Licence: CA 17458) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2007-07-08 |