| NPI | 1639222946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC23422) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA 23422) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA 23422) | |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2025-08-07 |