| NPI | 1699842385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC22589) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA DC22589) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2008-06-24 |