| NPI | 1972558963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: HI 1495) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 22109) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-10-25 |