| NPI | 1851772131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33314) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: CA 33314) |
| 111NX0800X Chiropractor Orthopedic (Licence: CA 33314) | |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2023-03-09 |