| NPI | 1386222164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34516) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CA 34516) |
| 111NX0100X Chiropractor, Occupational Health (Licence: CA 34516) | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2021-03-31 |