| NPI | 1790863959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA CA DC 16494) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA CA DC 16949) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2009-01-21 |