| NPI | 1245339159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: CA 10642) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 10642) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2024-05-01 |