| NPI | 1326066978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7432) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: AZ 4118) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2022-08-15 |