| NPI | 1326263278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: CA DC 29449) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA DC29449) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2019-03-08 |