| NPI | 1124137732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC18337) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA15393) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2025-09-11 |