| NPI | 1043806664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 35066) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 6122) |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: CA 35066) | |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2023-09-06 |