| NPI | 1952975211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 36087) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 6044) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2026-05-20 |