| NPI | 1578947990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA dc33298) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 5903) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2026-06-02 |