| NPI | 1437712528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8802) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 5373) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2019-04-15 |