| NPI | 1710536735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1501) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34119) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2021-11-03 |