| NPI | 1285746388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI DC-492) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5539) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-09 |