| NPI | 1982679858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC29913) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CA Dc29913) |
| 171100000X Acupuncturist (Licence: CA AC11228) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2019-08-09 |