| NPI | 1275767212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1144) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 29854) |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2009-05-05 |