| NPI | 1114931169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 27748) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA 27748) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-01-21 |