| NPI | 1225119233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CA 20076) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 20076) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2015-11-30 |