| NPI | 1285974378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8970) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557055) |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2023-02-28 |