| NPI | 1427230259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1125) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NM 1435) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2013-02-28 |