| NPI | 1801969308 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 171100000X Acupuncturist (Licence: CA AC 7990)  | 
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC27435)  | 
| Enumeration Date | 2006-11-15 | 
| Last Update Date | 2025-09-11 |