| NPI | 1760668446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI CHR-1380) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR-6150) |
| Enumeration Date | 2008-01-13 |
| Last Update Date | 2024-10-07 |