| NPI | 1023628229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 34890) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34890) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2020-08-04 |