| NPI | 1245605583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8484) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: AZ 8484) |
| 111NN0400X Chiropractor, Neurology (Licence: AZ 8484) | |
| 111NN1001X Chiropractor, Nutrition (Licence: AZ 8484) | |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: AZ 8484) | |
| 111NR0200X Chiropractor, Radiology (Licence: AZ 8484) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: AZ 8484) | |
| 111NT0100X Chiropractor, Thermography (Licence: AZ 8484) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: AZ 8484) | |
| Enumeration Date | 2015-12-12 |
| Last Update Date | 2015-12-12 |