| NPI | 1306804984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 4343) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: AZ 4343) |
| 171100000X Acupuncturist (Licence: AZ 0148) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2012-09-24 |