| NPI | 1477701555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CA 30917) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 30917) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2022-05-18 |