| NPI | 1437482213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8072) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 4730) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2009-09-11 |