| NPI | 1114013968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 6018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 3614) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2023-10-10 |