| NPI | 1255646881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 6371268) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC31739) |
| Enumeration Date | 2010-08-06 |
| Last Update Date | 2026-01-21 |