| NPI | 1952478372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC13989) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CO 00) |
| 146N00000X Emergency Medical Technician, Basic (Licence: CA E152026) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: UT 9855511-4810) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO Diplomate) | |
| 225700000X Massage Therapist (Licence: CA DC13989) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2025-03-21 |