| NPI | 1346208360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ AZ5711) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5711) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2022-04-15 |