| NPI | 1699885608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC161210) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: CA DC16121) |
| 111NN1001X Chiropractor Nutrition (Licence: CA DC16121) | |
| 111NR0200X Chiropractor Radiology (Licence: CA DC16121) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2009-03-31 |