| NPI | 1194109892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8651) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33329) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2022-12-27 |