| NPI | 1073655650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7603) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00391100) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2009-10-02 |