| NPI | 1275576936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ DC5592) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: AZ 3235) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2022-04-22 |