| NPI | 1790760957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1484) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31047) |
| 111N00000X Chiropractor (Licence: AZ 7045) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2021-09-24 |