| NPI | 1639525983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33553) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 16999) |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2022-01-23 |