| NPI | 1013985415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7327) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 4012) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2008-02-20 |