| NPI | 1518176239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CA D.C.22498) |
| Additional Taxonomies | 111NT0100X Chiropractor Thermography (Licence: CA D.C.22498) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |