| NPI | 1235074907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 31412) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CA 31412) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA 31412) | |
| Enumeration Date | 2026-04-21 |
| Last Update Date | 2026-04-21 |