| NPI | 1215098058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4974) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: AZ 221) |
| 174400000X Specialist (Licence: AZ 2790) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2012-06-28 |