| NPI | 1205830650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 3121) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: AZ 3121) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2012-06-18 |