| NPI | 1972585297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 20968) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: CA 20968) |
| 111NX0100X Chiropractor Occupational Health (Licence: CA 20968) | |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2010-01-26 |