| NPI | 1215115738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM 2061) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 3961) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2022-07-21 |