| NPI | 1568430627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC14594) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA DC14594) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |