| NPI | 1851652382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC31865) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA CA-DC31865) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2015-05-12 |