| NPI | 1255544607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA dc16645) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC16645) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2016-04-21 |