| NPI | 1235684317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4399) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 2750) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2019-01-04 |