| NPI | 1104883164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5935) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: AZ 1058) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2007-07-08 |