| NPI | 1619935632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC28462) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC943) |
| 111N00000X Chiropractor (Licence: TX 142065) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2023-04-24 |