| NPI | 1245406503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28479) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA PA19724) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2021-10-13 |