| NPI | 1427474022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8441) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 072692) |
| Enumeration Date | 2014-03-07 |
| Last Update Date | 2015-08-10 |