| NPI | 1346390275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7315) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: AZ 4065) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2012-06-13 |