| NPI | 1619194248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 21269) |
| Additional Taxonomies | 111NR0400X (Licence: CA 21269) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2008-07-21 |