| NPI | 1164726717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8174) |
| Additional Taxonomies | 111NR0400X (Licence: AZ 8174) |
| 111NS0005X Chiropractor, Sports Physician (Licence: AZ 8174) | |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2021-05-10 |