| NPI | 1487750543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1307) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 273414) |
| 111NR0400X (Licence: UT 6322750-1202) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2015-07-17 |