| NPI | 1457379323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7373) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: AZ 4104) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-02-18 |