| NPI | 1841315108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC 12408) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CA Dc 12408) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC 12408) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2025-09-11 |