| NPI | 1932404712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC30817) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CA DC30817) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2025-03-19 |