| NPI | 1023505096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8237) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 7561) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2026-03-06 |