| NPI | 1659592475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 23555) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: AZ 8467) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2015-10-02 |