| NPI | 1659884617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC32536) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC18770) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2021-05-07 |