| NPI | 1720204670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 23901) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: CA DC 23901) |
| 111NN0400X Chiropractor, Neurology (Licence: CA DC 23901) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2011-09-20 |