| 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 |