| NPI | 1043545445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8438) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OR 3933) |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2021-08-31 |