| NPI | 1245327394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7764) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 4447) |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2020-01-19 |