| NPI | 1972096717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC31074) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC18363) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2020-06-13 |