| 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 |