| NPI | 1598941221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC30724) |
| Additional Taxonomies | 111NR0400X (Licence: CA DC30724) |
| Enumeration Date | 2008-01-11 |
| Last Update Date | 2008-01-11 |