| NPI | 1104937234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7214) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 3903) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |