| NPI | 1558376251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC18242) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 18242) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2015-04-27 |