| NPI | 1891224614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SD 1512) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33884) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2025-09-04 |