| NPI | 1104245463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 32909) |
| Additional Taxonomies | 111NR0400X (Licence: CA 32909) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA 32909) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2024-06-24 |