| NPI | 1356664254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8142) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 007300) |
| Enumeration Date | 2010-03-05 |
| Last Update Date | 2010-07-14 |