| NPI | 1265177729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 35221) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3775) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2024-06-27 |