| NPI | 1376672675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC15395) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: UT 5313705-4701) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2024-05-10 |