| NPI | 1720066954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28417) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC0284170) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2022-06-30 |