| NPI | 1811590409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6111) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 35157) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2025-08-31 |