| NPI | 1194886952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7326) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 4010) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2011-12-23 |