| NPI | 1164634184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7121) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC26587) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2017-01-05 |