| NPI | 1750730081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33600) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CA 33600) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CA 33600) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2020-11-12 |