| NPI | 1336245554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8053) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3575-012) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2020-01-25 |