| NPI | 1770180895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34782) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: CA 35782) |
| 111NX0100X Chiropractor, Occupational Health (Licence: CA 34782) | |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |