| NPI | 1548570740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 31788) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 13819) |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2022-06-13 |