| NPI | 1487425120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332800000X Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy (Licence: NV 202200389) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC36794) |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-01-23 |