| NPI | 1821585357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: IA 081984) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33702) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2020-03-26 |