| NPI | 1386094415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2208) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 33605) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2019-03-15 |