NPI | 1548231244 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC22873) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NM 1266) |
Enumeration Date | 2006-01-30 |
Last Update Date | 2021-06-15 |