| NPI | 1770801011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28542) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 16478) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2020-07-08 |