| NPI | 1760052930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36374) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH61099066) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2025-04-24 |