| NPI | 1609313535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 9381) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33767) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2025-03-26 |