| 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 |