| NPI | 1194961193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9358) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: OR 15666) |
| Enumeration Date | 2008-12-21 |
| Last Update Date | 2024-12-12 |