| NPI | 1346356896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5917) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008216) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-02-21 |