| NPI | 1679240048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36140) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.024441) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2026-05-29 |