| NPI | 1366273344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2327) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 37030) |
| Enumeration Date | 2024-08-12 |
| Last Update Date | 2025-07-15 |