NPI | 1972675403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CA DC23744) |
Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: CA DC23744) |
Enumeration Date | 2006-11-13 |
Last Update Date | 2021-09-13 |