| NPI | 1164449195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 17334) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 1539) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2025-09-11 |