| NPI | 1215099973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8515) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC30400) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2016-05-24 |