| NPI | 1023760956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC34931) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34931) |
| Enumeration Date | 2022-01-21 |
| Last Update Date | 2022-01-21 |