| NPI | 1821308339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1344) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2010012550) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2020-10-12 |