| NPI | 1497289524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33859) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC33859) |
| Enumeration Date | 2017-04-15 |
| Last Update Date | 2024-07-22 |