| NPI | 1114747987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC37389) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA 706219) |
| Enumeration Date | 2024-10-15 |
| Last Update Date | 2025-10-01 |