| NPI | 1265658249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5563) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 952947271202) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2007-07-08 |