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 |