| NPI | 1003113259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32020) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA 32020) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2020-04-19 |