| NPI | 1154433290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7669) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4349) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-07-31 |