| NPI | 1376560011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 5295) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC15200) |
| 111N00000X Chiropractor (Licence: NV B01311) | |
| 111NI0013X Chiropractor, Independent Medical Examiner (Licence: CA dc 15200) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-12-07 |