| NPI | 1407217540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33523) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 33523) |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2026-01-21 |