| NPI | 1427117696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8005) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: AZ 3780) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2012-03-12 |