| NPI | 1619966140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC-1040) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2018-03-17 |