| NPI | 1083837785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4666) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 04666) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-12-17 |