| NPI | 1689309940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: UT 12744966-1202) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA 36325) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2024-07-31 |