| NPI | 1629528112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AR 16183) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33715) |
| 171100000X Acupuncturist (Licence: CA 17810) | |
| 171100000X Acupuncturist (Licence: AR 076) | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2023-06-27 |