| NPI | 1104805332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7490) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 4180) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2020-11-10 |