| NPI | 1760849319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33108) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038005348) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2026-02-17 |