| NPI | 1790032571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: CA A203406) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A203406) |
| 111N00000X Chiropractor (Licence: CA DC32385) | |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2025-11-14 |