| NPI | 1821013848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC25059) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC-1062) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2011-10-21 |