| NPI | 1790179117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34562) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60540813) |
| 171100000X Acupuncturist (Licence: CA 19268) | |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2024-03-12 |