| NPI | 1457163362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 35069) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 35069) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-02-04 |