| NPI | 1134463102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 87) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: HI 87) |
| 111NN1001X Chiropractor, Nutrition (Licence: HI 87) | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2012-11-15 |