| NPI | 1134309867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8143) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30747) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2013-03-12 |