| NPI | 1861449738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6087) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC0278350) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2026-05-14 |