| NPI | 1558759258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1227) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 27992) |
| Enumeration Date | 2015-01-03 |
| Last Update Date | 2015-01-03 |