| NPI | 1700916160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC24609) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY X0096731) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-07-08 |