NPI | 1760587364 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC27596) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC27596) |
111NX0100X Chiropractor, Occupational Health (Licence: CA DC27596) | |
111NX0800X Chiropractor, Orthopedic (Licence: CA DC27596) | |
Enumeration Date | 2006-09-14 |
Last Update Date | 2008-09-09 |