| NPI | 1225193147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 6098) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 3683) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2012-11-13 |