| NPI | 1174654800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8776) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC 26307) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2026-01-02 |