| NPI | 1053588962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5768) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2717) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-09 |