| NPI | 1548597651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID 2272) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MT 1250) |
| 111N00000X Chiropractor (Licence: CA DC-31448) | |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2026-07-23 |