| NPI | 1205948387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7293) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 3974) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-07-01 |