| NPI | 1093983009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9251) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4591) |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2026-02-21 |