| NPI | 1124227418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7567) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: AZ 7567) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2013-05-03 |