| NPI | 1295256600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI DC-1413) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34001) |
| 111N00000X Chiropractor (Licence: CO CHR.0007637) | |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2018-09-26 |