| NPI | 1386989622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1035) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 25770) |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2012-11-27 |