| NPI | 1457586695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC26928) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA DC26928) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2009-05-18 |