| NPI | 1669094645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36622) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010362) |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2025-12-04 |