| NPI | 1023192143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 343) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 3364R) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2008-05-14 |