| NPI | 1053378042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 0959) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: AZ 1386) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-09-24 |