| NPI | 1265821672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC33008) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC33008) |
| Enumeration Date | 2015-01-22 |
| Last Update Date | 2022-10-05 |