| NPI | 1689672099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 23764) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA 23764) |
| 111NX0100X Chiropractor Occupational Health (Licence: CA 23764) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2010-10-22 |