| NPI | 1730260878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: CA 23256) |
| Additional Taxonomies | 111NX0100X Chiropractor Occupational Health (Licence: CA 23256) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2007-07-09 |