| NPI | 1891917514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI DC 1082) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 18776) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |