| NPI | 1720204043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC 23972) |
| Additional Taxonomies | 111NR0400X (Licence: CA DC 23972) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA DC 23972) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-08 |