| NPI | 1669543179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA D.C.0199990) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC19999) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2010-07-02 |