| NPI | 1053895359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34309) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA 34309) |
| 111NN1001X Chiropractor Nutrition (Licence: CA 34309) | |
| 111NT0100X Chiropractor Thermography (Licence: CA 34309) | |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2018-09-21 |