| NPI | 1235227364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7077) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 3751) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-11-08 |