| NPI | 1588856868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor, Occupational Health (Licence: CA 19031) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 19031) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2021-04-20 |