| NPI | 1972152700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI DC-1571-0) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CHIR.CH.06984065) |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2023-06-06 |