| 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 |