| NPI | 1174982326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 36120) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 2136) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2025-02-07 |