| NPI | 1427347657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8273) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 6608) |
| 225400000X Rehabilitation Practitioner (Licence: CO 6608) | |
| 111NR0400X (Licence: AZ 4921) | |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2012-08-08 |