| NPI | 1629365945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GU C-42) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: GU ACOM-24) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2025-10-03 |