| NPI | 1699007872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC31509) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC-31509) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2013-08-01 |