| NPI | 1215933783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: AZ 3837) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: ND 423) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2010-10-22 |