| NPI | 1306988993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ AZ0234870) |
| Additional Taxonomies | 111NR0400X (Licence: AZ AZ0234870) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-01-30 |