| NPI | 1801555073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC36204) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 36204) |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2023-11-17 |