| NPI | 1720237357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 31016) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA 12429) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2025-10-23 |