| NPI | 1841643319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33626) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: CA 33626) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: CA 33626) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: CA 33626) | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2023-08-01 |