| NPI | 1659774941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA 16691) |
| Additional Taxonomies | 111NR0400X (Licence: CA 16691) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2014-10-01 |