| NPI | 1700943560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28686) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC10783) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-04-17 |