| NPI | 1710903927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC15136) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: CA DC15136) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2014-05-09 |