| NPI | 1114657095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 36371) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 0008648) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-10-14 |