| NPI | 1679802227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CA 30512) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 12468) |
| Enumeration Date | 2009-12-10 |
| Last Update Date | 2012-02-06 |